Other medicines for migraine

If triptans don’t prove effective, a dihydroergotamine (Dihydergot) injection may be suggested by your doctor.

Dihydroergotamine belongs to a group of medicines known as the ‘ergot alkaloids’. It is generally only used if other treatments have been carefully tried and are not effective, and not everybody will experience a benefit.

Dihydroergotamine should be used at the onset of a migraine attack. It must always be used  exactly as directed, as overdosing can lead to serious side effects. Dihydroergotamine should also not be taken on more than 10 days per month, otherwise medication overuse headache can develop.

Common side effects of dihydroergotamine include nausea, vomiting, stomach pain, muscle cramps, ‘pins and needles’ and cold hands and feet. This medicine is not suitable for everybody; the restrictions on its use are the same as for the triptans — see Who can’t take triptans?

Dihydroergotamine should not be taken within 24 hours of a triptan as this may increase the risk of serious side effects.

References
  • British Association for the Study of Headache. Guidelines for all health professionals in the diagnosis and management of migraine, tension-type-type headache, cluster headache and medication overuse headache. Hull: BASH, 2010. www.bash.org.uk (accessed 13 December 2011)
  • Neurology Writing Group. Therapeutic Guidelines: Neurology, Version 4 Updated November 2011 [eTG complete CD-ROM]. Melbourne: Therapeutic Guidelines Ltd, 2011.
  • Rossi S, ed. Australian Medicines Handbook. Adelaide: Australian Medicines Handbook Pty Ltd, 2012.
  • Scottish Intercollegiate Guidlines Network. Diagnosis and management of headache in adults. Edinburgh: NHS Quality Improvement Scotland, 2008. www.sign.ac.uk/pdf/sign107.pdf (accessed 19 December 2011).
  • Evers S, Afra J, Frese A, et al. EFNS guideline on the drug treatment of migraine - a revised report of an EFNS task force. European Journal of Neurology 2009;16:968-81. www.efns.org/fileadmin/user_upload/CME_articles/CME_article_2009_September.pdf